Therapeutic Communication Techniques (Recommended to use when interacting with a patient)

Examples

Rationale

Silence 

-Absence of verbal communication

1. Interested, expectant silences often encourage the patient to verbalize.

2. Silence allows the patient an opportunity to take the initiative in communication that, which is most pressing.

3. Silence reduces the pace of the interview.

4. Silence allows time to consider alternatives and to weigh questions.

5. Nonverbal communications occur during silences.

Accepting

-Giving indication of reception.

“Yes”

“Nodding”

“I follow what you said.”

1. Such responses signify that the nurse is attuned to the patient.

2. Accepting does not indicate agreement, but is nonjudgmental in nature.

3. Facial expression, inflection, posture, etc. must convey acceptance as well as verbal acceptance.

Giving recognition

-Acknowledging, indicating awareness.

“Good morning, Miss Jones.”

“I notice you’ve combed your hair.”

1. Such recognition indicates perception of the patient as an individual.

2. Recognition carries no value judgments of “good” or “bad”, etc., thus does not burden the patient with expected behaviors.

Offering self

-Making one’s self available

“I’ll sit with you awhile.”

“I’ll stay here with you.”

1. The presence and interest of the nurse may be therapeutic when verbal communications are not timely.

2. To be therapeutic, this offer must be un-conditional, not contingent on patient behavior.

3. Conditions, which are applicable, should be stated, as time available, etc.

Giving broad openings

-Allowing the patient to take the initiative in introducing the topic.

“Where would you like to begin?”

“Is there something you’d like to talk about?”

1. Such comments help the patient to identify his role in the interaction.

2. The nurse should avoid conventional “small talk” when greeting the patient.

Offering general leads

-Giving encouragement to continue

“Go on…”

“Tell me about it.”

1. Leads encourage the patient to talk.

2. Following the patient’s lead involves taking cues from the patient rather than the nurse directing the discussion.

Placing the events in time or in sequence   

-Clarifying the relationships of events in time.

“Was this before or after…?”

“When did this happen?”

1. Sequence helps the nurse and patient view events in perspective.

2. Objectivity is enhanced when chronologic order is established.

3. Cause and effect relationships can be better studied.

4. Recurring patterns of interpersonal difficulties may be identified.

Making observations 

-Verbalizing what is perceived.

“You appear tense.”

“I noticed you’re biting your lips.”

1. Observations can be called to the attention of the patient, who may be unaware of them.

2. Stating observations encourages the patient’s noticing for himself so he can describe the same.

3. The nurse and patient can compare observations

Encouraging descriptions of perceptions

-Asking the patient to verbalize what he perceives.

“Tell me when you feel anxious.”

“What is happening?”

1. Patient descriptions allow the nurse to see things as they seem to the patient.

2. Descriptions of behavior are necessary for understanding reasons for behavior.

3. Talking may make it unnecessary to act out harmful behavior.

Restating   

-Repeating the main idea expressed.

Pt:  “I can’t sleep.  I stay awake all night.”

Nurse:  “You have difficulty sleeping.”

1. Restatement gives evidence that the idea has been communicated.

2. The patient is encouraged of continue.

3. An opportunity to restate for clarity is provided.

4. Restatement may bring out related aspects, which have been omitted.

Reflecting   

-Directing back to the patient questions, feelings, and ideas.

Pt:  “Do you think I should tell the doctor?”

Nurse:  “Do you think you should tell the doctor?”

1. Refection encourages acceptance of one’s own ideas and feelings.

2. The patient’s point of view is given value.

3. Reflection makes obvious the nurse’s interest in hearing as much as the patient needs to tell.

Giving information

-Making available the facts the patient needs.

“My purpose in being here is…”

“Visiting hours are…”

1. Providing needed facts builds trust and enhances knowledge for decision making.

2. When the nurse does not have knowledge required, she should state she does not know, but seek such information or make proper referrals.

3. Misleading or vague explanations should be avoided.

Seeking clarification

-Seeking to make clear that which is not meaningful or which is vague.

“I’m not sure that I understand.”

“Have I heard you correctly, you said…?”

1. Patients are often aware of not being understood, and will eventually cease to try to communicate.

2. It is not necessary to understand everything said, but pretenses of understanding should be avoided.

3. Attempts to clarify communications for others may enhance self-understanding.